Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery

Albert AA, Beller C, Walter JA, Arnrich B, Rosendahl UP, Priss H, Ennker J (2003)
The Annals of Thoracic Surgery 75(5): 1550-1557.

Journal Article | Published | English

No fulltext has been uploaded

Author
; ; ; ; ; ;
Abstract
Background Stroke after cardiac surgery is a devastating complication. The relationship between white blood cell count (WBC) and perioperative cerebrovascular accident (CVA) has not been investigated. An effort was made to identify how preoperative WBC may relate to CVA development during or after cardiac surgery. Methods Prospective data were collected from 7,483 patients who underwent coronary artery bypass grafting or valvular surgery or both. WBC was determined preoperatively and postoperatively. Differentiation of WBC was examined only preoperatively. Results There were a total of 125 CVAs (10 transient ischemic attacks [TIAs], 115 strokes). WBC was significantly higher preoperatively and directly postoperatively in patients with stroke. Qualitative changes in preoperative WBC were also found in these patients (χ2; p < 0.001). The predictive power of the stepwise logistic regression model for CVA was greater when preoperative WBC was included. The risk for perioperative CVA increased starting at preoperative WBC of 9 × 109/L (p = 0.044) and progressed in higher WBC ranges. WBC had a significant impact on CVA outcome (analysis of variance, p = 0.001). Conclusions Our studies have established the correlation between high preoperative WBC and stroke during or after cardiac surgery. Furthermore, elevated preoperative WBC was related to the clinical outcome of CVA. Preoperative measures aimed at preventing or treating conditions such as infections that may cause elevated WBC may be beneficial in the prevention of stroke during or after cardiac surgery.
Publishing Year
eISSN
PUB-ID

Cite this

Albert AA, Beller C, Walter JA, et al. Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery. The Annals of Thoracic Surgery. 2003;75(5):1550-1557.
Albert, A. A., Beller, C., Walter, J. A., Arnrich, B., Rosendahl , U. P., Priss, H., & Ennker, J. (2003). Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery. The Annals of Thoracic Surgery, 75(5), 1550-1557.
Albert, A. A., Beller, C., Walter, J. A., Arnrich, B., Rosendahl , U. P., Priss, H., and Ennker, J. (2003). Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery. The Annals of Thoracic Surgery 75, 1550-1557.
Albert, A.A., et al., 2003. Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery. The Annals of Thoracic Surgery, 75(5), p 1550-1557.
A.A. Albert, et al., “Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery”, The Annals of Thoracic Surgery, vol. 75, 2003, pp. 1550-1557.
Albert, A.A., Beller, C., Walter, J.A., Arnrich, B., Rosendahl , U.P., Priss, H., Ennker, J.: Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery. The Annals of Thoracic Surgery. 75, 1550-1557 (2003).
Albert, Alexander A., Beller, Carsten, Walter, Jörg A., Arnrich, Bert, Rosendahl , Ulrich P., Priss, Horst, and Ennker, Jürgen. “Preoperative High Leukocyte Count: A Novel Risk Factor for Stroke after Cardiac Surgery”. The Annals of Thoracic Surgery 75.5 (2003): 1550-1557.
This data publication is cited in the following publications:
This publication cites the following data publications:

13 Citations in Europe PMC

Data provided by Europe PubMed Central.

Neutrophil Lymphocyte Ratio as a predictor of systemic inflammation - A cross-sectional study in a pre-admission setting.
Venkatraghavan L, Tan TP, Mehta J, Arekapudi A, Govindarajulu A, Siu E., F1000Res 4(), 2015
PMID: 26213612
Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review.
Tan TP, Arekapudi A, Metha J, Prasad A, Venkatraghavan L., ANZ J Surg 85(6), 2015
PMID: 25781147
Organ protective mechanisms common to extremes of physiology: a window through hibernation biology.
Quinones QJ, Ma Q, Zhang Z, Barnes BM, Podgoreanu MV., Integr. Comp. Biol. 54(3), 2014
PMID: 24848803
Association of total white cell count with mortality and major adverse events in patients with peripheral arterial disease: a systematic review.
Martin D, Wallace D, Crowe M, Rush C, Tosenovsky P, Golledge J., Eur J Vasc Endovasc Surg 47(4), 2014
PMID: 24485842
Immature circulating neutrophils in sepsis have impaired phagocytosis and calcium signaling.
Taneja R, Sharma AP, Hallett MB, Findlay GP, Morris MR., Shock 30(6), 2008
PMID: 18496237
Cerebrovascular accidents in patients with a ventricular assist device.
Tsukui H, Abla A, Teuteberg JJ, McNamara DM, Mathier MA, Cadaret LM, Kormos RL., J. Thorac. Cardiovasc. Surg. 134(1), 2007
PMID: 17599496
Perioperative stroke.
Selim M., N. Engl. J. Med. 356(7), 2007
PMID: 17301301
[Should we avoid cardiopulmonary bypass with diabetic patients?]
Albert A, Ennker J, Sergeant P., Clin Res Cardiol 95 Suppl 1(), 2006
PMID: 16598547
White blood cell count and the incidence of ischemic stroke in coronary heart disease patients.
Koren-Morag N, Tanne D, Goldbourt U., Am. J. Med. 118(9), 2005
PMID: 16164887

22 References

Data provided by Europe PubMed Central.

Impairments of the protein C system and fibrinolysis in infection-associated stroke.
Macko RF, Ameriso SF, Gruber A, Griffin JH, Fernandez JA, Barndt R, Quismorio FP Jr, Weiner JM, Fisher M., Stroke 27(11), 1996
PMID: 8898806
Recent bacterial and viral infection is a risk factor for cerebrovascular ischemia: clinical and biochemical studies.
Grau AJ, Buggle F, Becher H, Zimmermann E, Spiel M, Fent T, Maiwald M, Werle E, Zorn M, Hengel H, Hacke W., Neurology 50(1), 1998
PMID: 9443480
Der erweiterte Datensatz Kardioanästhesie
schirmer, an�sthesiologie intensivmedizin 41(), 2000
Classification of cerebrovascular disease III. Special report from the National Institute of Neurological Disorders and Stroke
whisnant, stroke 21(), 1990
Immunohematologic characteristics of infection-associated cerebral infarction.
Ameriso SF, Wong VL, Quismorio FP Jr, Fisher M., Stroke 22(8), 1991
PMID: 1866745
Persistent inflammatory response in stroke survivors.
Beamer NB, Coull BM, Clark WM, Briley DP, Wynn M, Sexton G., Neurology 50(6), 1998
PMID: 9633717
Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL-6 levels.
Wedzicha JA, Seemungal TA, MacCallum PK, Paul EA, Donaldson GC, Bhowmik A, Jeffries DJ, Meade TW., Thromb. Haemost. 84(2), 2000
PMID: 10959691
Correlations between peripheral differential leukocyte counts and carotid atherosclerosis in non-smokers.
Huang ZS, Jeng JS, Wang CH, Yip PK, Wu TH, Lee TK., Atherosclerosis 158(2), 2001
PMID: 11583723
Stroke in cardiac surgical patients: determinants and outcome.
Almassi GH, Sommers T, Moritz TE, Shroyer AL, London MJ, Henderson WG, Sethi GK, Grover FL, Hammermeister KE., Ann. Thorac. Surg. 68(2), 1999
PMID: 10475402
Leukocyte count, diabetes mellitus and age are strong predictors of stroke in a rural population in southern Italy: an 8-year follow-up.
Noto D, Barbagallo CM, Cavera G, Cefalu' AB, Caimi G, Marino G, Lo Coco L, Caldarella R, Notarbartolo A, Averna MR., Atherosclerosis 157(1), 2001
PMID: 11427225
Dental infections in association with cerebral infarction in young and middle-aged men.
Syrjanen J, Peltola J, Valtonen V, Iivanainen M, Kaste M, Huttunen JK., J. Intern. Med. 225(3), 1989
PMID: 2703800
Cerebrospinal fluid and peripheral white blood cell response to acute cerebral ischemia.
Suzuki S, Kelley RE, Reyes-Iglesias Y, Alfonso VM, Dietrich WD., South. Med. J. 88(8), 1995
PMID: 7631206
Evaluation of neurologic assessment and outcomes in cardiac surgical patients.
Baker RA, Andrew MJ, Knight JL., Semin. Thorac. Cardiovasc. Surg. 13(2), 2001
PMID: 11494206
Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators.
Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C., N. Engl. J. Med. 335(25), 1996
PMID: 8948560
Leukocyte involvement in cerebral infarct generation after ischemia and reperfusion.
Heinel LA, Rubin S, Rosenwasser RH, Vasthare US, Tuma RF., Brain Res. Bull. 34(2), 1994
PMID: 8044688
Experimental antileukocyte interventions in cerebral ischemia.
Hartl R, Schurer L, Schmid-Schonbein GW, del Zoppo GJ., J. Cereb. Blood Flow Metab. 16(6), 1996
PMID: 8898682
Leukocytosis in acute stroke: relation to initial stroke severity, infarct size, and outcome: the Copenhagen Stroke Study.
Kammersgaard LP, Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS., J Stroke Cerebrovasc Dis 8(4), 1999
PMID: 17895174
Cytokine production pathway in the elderly.
Caruso C, Candore G, Cigna D, DiLorenzo G, Sireci G, Dieli F, Salerno A., Immunol. Res. 15(1), 1996
PMID: 8739567
Leukocytosis: a new look at an old marker for acute myocardial infarction.
Green SM, Vowels J, Waterman B, Rothrock SG, Kuniyoshi G., Acad Emerg Med 3(11), 1996
PMID: 8922012
Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).
Struck E, De Vivie ER, Hehrlein F, Hugel W, Kalmar P, Sebening F, Wilde E., Thorac Cardiovasc Surg 38(2), 1990
PMID: 2190348

Export

0 Marked Publications

Open Data PUB

Web of Science

View record in Web of Science®

Sources

PMID: 12735578
PubMed | Europe PMC

Search this title in

Google Scholar